An interventional study of Intramuscular quadratus lumborum block and Lateral quadratus lumborum block in Bilateral, Ultrasound and Intramuscular Quadratus Lumborum Plane Block, sponsored by National Cancer Institute, Egypt. Recruiting at 1 site in Egypt. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2025-03-21.
Sponsored by National Cancer Institute, Egypt · Not applicable, Interventional, and Treatment
This study aims to evaluate the efficacy of bilateral ultrasound-guided intramuscular quadratus lumborum plane block (QL4) versus bilateral lateral quadratus lumborum plane block (QL1) in controlling postoperative pain in cancer patients undergoing open nephrectomy.
Post-surgical somatic pain is very distressing to patients, which may lead to significant complications.
Practitioners initially used these as ilioinguinal, iliohypogastric, rectus sheath blocks, and in the early 21st century, transversus abdominis plane (TAP) blocks. A recent variation of the TAP block is known as the quadratus lumborum block (QLB).
The QL block effectiveness is believed to result from the spread of Local Anesthetic cranially from the lumbar deposition into the thoracic paravertebral space (TPVS). So, the QLB seems to relieve somatic and visceral pains.
5,093 studies on the registry are indexed under Pain, Postoperative; 1,140 are open to participants now.
This study's planned enrollment of 90 is above the median of 75 across 4,344 interventional studies indexed under Pain, Postoperative.
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Exclusion Criteria:
Patients will receive bilateral ultrasound-guided intramuscular quadratus lumborum block with an injection of 0.4 ml/kg bupivacaine 0.25% after induction of general anesthesia.
Drug: Intramuscular quadratus lumborum block
Patients will receive bilateral Ultrasound-guided lateral quadratus lumborum with injection of 0.4 ml/kg of bupivacaine 0.25 after induction of general anesthesia.
Drug: Lateral quadratus lumborum block
Patients will receive only general anesthesia without any block
Drug: General anesthesia
Patients will receive bilateral ultrasound-guided intramuscular quadratus lumborum block with an injection of 0.4 ml/kg bupivacaine 0.25% after induction of general anesthesia
Also known as: Bupivacaine 0.25%
Patients will receive bilateral ultrasound-guided lateral quadratus lumborum with an injection of 0.4 ml/kg of bupivacaine 0.25 after induction of general anesthesia.
Also known as: Bupivacaine 0.25%
Patients will receive only general anesthesia without any block.
Degree of pain
The degree of pain will be assessed using the Visual Analogue Scale (VAS) where 0 (no pain) and 10 (the worst pain). VAS score in each technique at 0, 2, 4, 8, 12, 16, 20 and 24 hours postoperatively
Time frame: 24 hours postoperatively
Total amount of morphine consumption
Rescue analgesia will be provided in the form of IV morphine 3 mg boluses if the patient indicates Visual Analogue Scale (VAS) ≥ 4. The total amount of morphine given in 24 hours will be recorded for the two groups. A maximum dose of 0.5 mg/kg/24hours of morphine is allowed.
Time frame: 24 hours postoperatively
Total amount of fentanyl consumption
Rescue analgesia of fentanyl 1 μg/kg will be given if the mean arterial blood pressure or heart rate rises above 20% of baseline levels.
Time frame: Intraoperatively
Change in heart rate
Change in heart rate will be recorded intraoperatively at 5-minute intervals and record the average of each three successive readings, then at 0, 4, 8, 12, 16, 20 and 24 hours postoperatively.
Time frame: 24 hours postoperatively
Change in mean arterial blood pressure
Change in mean arterial blood pressure will be recorded intraoperatively at 5-minute intervals and record the average of each three successive readings, then at 0, 4, 8, 12, 16, 20 and 24 hours postoperatively.
Time frame: 24 hours postoperatively
Incidence of postoperative nausea and vomiting
Incidence of postoperative nausea and vomiting will be recorded.
Time frame: 24 hours postoperatively
Time of first rescue analgesia
Time of first rescue analgesia will be recorded from the end of surgery till first dose of morphine administrated.
Time frame: 24 hours postoperatively
Incidence of complications related to block
Incidence of complications related to block such as local anesthetic systemic toxicity and arterial puncture will be recorded.
Time frame: 24 hours postoperatively
Incidence of morphine related complications
Incidence of morphine-related complications such as respiratory depression, urine retention or pruritis will be recorded.
Time frame: 24 hours postoperatively
Degree of patient satisfaction
The patient will be classified in this group to be satisfied or not.
Time frame: 24 hours postoperatively
Plan to share: Yes — The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
Supporting information: Study protocol
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National Cancer Institute, Egypt